It Had to Happen

Right? I’ve been banging on about our kidneys for years now – only to be met with a deafening chorus of practitioners of all sorts chanting, “Yes! What about renal health & the best way for us to support it?! We haven’t been trained in this!!”

I hear you and I’m onto it.

You’ve no doubt heard me talk before about the incredible rise in Chronic Kidney Disease (CKD) and how often patients aren’t being alerted in the early stages because even though their renal deterioration is there for all to see in their basic bloods, it may be dismissed as a ‘normal part of ageing’…but for a population living longer and longer…holding onto our kidneys for life has never been more important! And yes, I’ve talked about what an incredibly powerful agent nutrition is for renal health – whether we’re talking dietary change (note: diet changing = game-changing), addressing even mild acidosis (that’s my talk in Slovakia), improving the microbiome for better urea handling – we should all be literate in this area of health because our contribution is potentially significant in both prevention and, within our scope, treatment.

But have we gone way way way back and checked in at Renal Health HQ (that’s like the Pond’s Institute but better) and asked ourselves…how much water do our kidneys need? Does anyone actually know the answer? Is there a role for therapeutic fluids? Are there situations when the relationship flips and H2O shifts from helping to harassing, an already burdened system?

Recently I was asked this question by a practitioner almost as an afterthought when discussing a patient with stage 4 CKD: “So water is still good for him, right? and how much?” and it stopped me dead in my tracks…because I thought…you know I really don’t know. Cue rolling up of sleeves, late nights of reading the literature and BOY have I been on journey with this one. Have you ever really looked at the evidence re what constitutes optimal water? While every Tallulah, Dakota, Harmony – that’s the Byron version of Tom Dick & Harry 😉 – out there on the street recites the 8 glasses a day rhetoric…any ideas what this is based on? And whether this is really adequate and how to easily ascertain what is sufficient in each of your patients?!

You know there’s research galore on niche topics like whether your dog can feel jealousy or the team of psychologists that found that playing Tetris for just 3 minutes stops you craving sex, alcohol and food… (seriously, google it…published 2016)….you’d think we would have completely understood the basics of human health and optimal hydration first right? Wrong…so apparently wrong…but there is some really good information finally coming to the surface…of a big pool of water 😉

You can read the best of the bunch here and here – that’s about a week’s worth of literate trawling I give to you with my blessings and some sweat and tears… or you can cut to the chase and listen to the latest Update in Under 30 and find out the answers and access a clinical tool to help with in-clinic assessment to boot 🙂

It seems almost farcical to question the merits of hydration for our renal health but is this actually the truism we have been lead to believe? Where does the recommendation of ‘8 glasses a day’ come from and what is the level of evidence to support it and in whom? Or should we in fact be setting our sights on output ie. 24 hr urinary volume, over input. Do all kidneys love water – or does this relationship change with the progressive impairment seen in CKD which affects up to 30% of our middle-aged population? When does hydration become harassment? The latest UU30 : Water & Our Kidneys – Helping or Harassing? Answers all these questions and more.

If you are a current Update in Under 30 subscriber, you will find this latest podcast already in the ‘active content’ of your online account or purchase the latest podcast here.

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